Infection prophylaxis

Abstract

Chemotherapy for HIV-related hematological malignancies is associated with an increased risk of infection due to myelosuppression and additional CD4 lymphocyte count loss. The risk of infection may be further increased by the presence of central venous catheters or by neutropenia associated with HIV infection. Prophylaxis against PcP is strongly recommended when the CD4 cell count falls below 200 cells/µl with trimethoprim-sulfamethoxazole being the agent of choice. Prophylactic fluoroquinolones may be advocated for patients undergoing intensive chemotherapy who are likely to have prolonged (>8 days) and profound (ANC <500 cells/µl) neutropenia. Prophylaxis against MAC is recommended for individuals with a CD4 cell count less than 50 cells/µl and systemic antifungal prophylaxis may be given to patients with CD4 counts <100 cells/µl. Herpes simplex prophylaxis should be generally offered only to patients with a history of herpes simplex virus infection.